Outcomes from out-of-hospital cardiac arrest (OHCA) may improve if rescuers perform chest compressions (CCs) deeper than the previous recommendation of 38–51 mm and consistent with the 2010 AHA Guideline recommendation of at least 51 mm. The aim of this study was to assess the relationship between CC depth and OHCA survival.

ENHANCED PERFUSION DURING ADVANCED LIFE SUPPORT IMPROVES SURVIVAL WITH FAVORABLE NEUROLOGIC FUNCTION IN A PORCINE MODEL OF REFRACTORY CARDIAC ARREST

To improve the likelihood for survival with favorable neurologic function after cardiac arrest, we assessed a new advanced life support approach using active compression-decompression cardiopulmonary resuscitation plus an intrathoracic pressure regulator.

For out-of-hospital cardiac arrest, authoritative, evidence-based recommendations have been made for regionalization of postarrest care. However, system-wide implementation of these guidelines has not been evaluated. Our hypothesis is that statewide regionalization of postarrest interventions, combined with emergency medical services (EMS) triage bypass, is associated with improved survival and neurologic outcome.

To evaluate CPR quality during cardiac resuscitation attempts in an urban emergency department (ED) and determine the influence of the combination of scenario-based training, real-time audiovisual feedback (RTAVF), and post-event debriefing on CPR quality.

This paper addresses the issue of scene resuscitation. It is generally accepted that treating the patient at the scene of collapse is the best strategy for optimizing survival. However, many EMS systems continue to implement the “scoop and go” technique.

This is an informative editorial that reviews current evidence for the use of medications during resuscitation. There is little evidence for efficacy of many of the resuscitation drugs used today. The author discusses the ongoing search for a vasopressor that facilitates resuscitation by optimizing cerebral and coronary blood flow.

In this Belgian study, the authors describe the relationship between compression rate and depth. This is good knowledge to help reinforce the correct rate, and to support faster is not necessarily better.

WIDE VARIABILITY IN DRUG USE IN OUT-OF-HOSPITAL CARDIAC ARREST: A REPORT FROM THE RESUSCITATION OUTCOMES CONSORTIUM.

This manuscript from the Resuscitation Outcomes Consortium reports the use of resuscitation drugs among the ROCs 11 sites and 74 EMS agencies. Despite the knowledge that there is limited data to show beneficial effects of many of the pharmacological agents routinely used during resuscitation, this study shows that among 16,221 out-of-hospital cases, 83 percent of patients received at least one drug.

Although this study showed that the use of real-time feedback during an actual resuscitation moved CPR parameters closer to recommended guidelines, the use of real-time feedback did not affect the clinical endpoints of ROSC or survival to hospital discharge. The authors suggest that the ability for real-time feedback to influence outcomes is only as good as the information used to formulate the CPR guidelines. They also suggest that the use of real-time feedback in systems with good quality baseline CPR performance may only produce small improvements insufficient to significantly impact survival.

THE EFFECTIVENESS OF ULTRABRIEF AND BRIEF EDUCATIONAL VIDEOS FOR TRAINING LAY RESPONDERS IN HANDS-ONLY CARDIOPULMONARY RESUSCITATION: IMPLICATIONS FOR THE FUTURE OF CITIZEN CARDIOPULMONARY RESUSCITATION TRAINING.

Bystander CPR is provided to about 1/3rd of out-of-hospital sudden cardiac arrest victims in the US. The low rate may be in part related to bystander’s fears about their ability to correctly perform complicated traditional CPR. Compression-only CPR is much simpler than traditional CPR and can be quickly and easily learned. Utilizing simple videos coupled with a more personalized approach to enlisting layperson participation in Arizona was the key to their success.

SURVIVAL AFTER APPLICATION OF AUTOMATIC EXTERNAL DEFIBRILLATORS BEFORE ARRIVAL OF THE EMERGENCY MEDICAL SYSTEM: EVALUATION IN THE RESUSCITATION OUTCOMES CONSORTIUM POPULATION OF 21 MILLION.

Use of AEDs by laypersons in the United States has remained at around 2-3%, despite increasingly available devices in high traffic areas. In a study completed in Amsterdam, researchers surveyed travelers in a rail station to determine bystander’s level of preparedness to provide emergency defibrillation. Among 1,018 responders from 38 nations, only 47% said they would be willing to use an AED, and 53% were unable to recognize an AED. This suggests that the general public still needs a substantial amount of education about how to recognize and operate an AED as well as to convey our expectations to the public, that their help is essential during such an emergency.

This study involved 10 pigs that received 60 minutes of nasopharyngeal cooling using the RhinoChill device during various states of blood flow prior to ROSC. While hypothermia therapy provided in the hospital setting has proven to have a strong survival benefit for patients, beginning the therapy in the prehospital setting, either before or after ROSC has not yet been shown to provide additional survival or neurologic benefits.

While the effect of pre-hospital cooling on survival remains uncertain at this writing, several groups are investigating the even earlier implementation of this therapy, during the intra-arrest period. The provision of both pre-hospital and intra-arrest cooling has scientific basis. Systems using unproven therapies should ensure that neurologic outcome at hospital discharge is measured and evaluated for all SCA cases.